Support for Collaborative Reflection in Healthcare: Comparing two Workplaces

Support for Collaborative Reflection in Healthcare: Comparing two WorkplacesMichael Prilla, Martin DegelingInformation and Technology Management, Ruhr University of Bochum

Fostering Collaborative Redesign of Work Practice: Challenges for Tools Supporting Reflection at Work

A Collaborative Reflection BlueprintArticulation and Essential Steps (Prilla, Degeling and Herrmann 2012)

Documentation/ data capturing(data about work)

The Talk Reflection AppCollaborative Reflection of Conversations

© MIRROR Project - Co-Funded by EU IST FP7 – www.mirror-project.eu 4

The Talk Reflection App Reflecting on conversations

Conversations as a central part of daily work in many workplaces▪Relatives, patients, residents, clients, citizens, …▪Physicians, nurses, caregivers, police, traffic wardens, call agents, managers, ….

Conversation as a burden▪Difficult handling and emotional stress vs. acting professionally


Using the Talk Reflection App

Document experiences

Comment on own/shared experiences

Document results from reflection


Evaluating the Talk Reflection App

Participants Data from studies

Case 1/3(Hospital) 5/6 physicians Questionnaires (Pre/Post),

interviews, observations (meetings), log filesCase 2

(Care home) 5 caregiver, 1 manager

© MIRROR Project - Co-Funded by EU IST FP7 – www.mirror-project.eu

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How does Collaborative Reflection Help?Reflecting on holding conversations with relatives (Case 3)

Reflection results created mainly by using the app: Sharing experience, exchanging perspectives, agreeing on change

Activity Articulation

Documented Conversation

“Patient with [diagnosis]. Excited relative talks about [problem] that she allegedly does not know about. Wants information about [the problem] and how we deal with it, which has already been given before.”

Own Comment “[Maybe] medical lay people cannot understand some terms and are irritated rather than informed.”

Comment by others “Here a second talk could help. Sometimes it needs to be explained again and again to reach understanding. (…) There is still the option to ask the senior physician”


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How does Collaborative Reflection Help?Creating results from reflection (Case 2)

Reflection results outside the app: Sharing experience, sustaining change proposals reflective communication outside the app

Activity Articulation Documented Conversation

„The resident passed away suddenly, had been here long, was liked by all staff. Was ill in the morning and her guardian admitted her to hospital, Unfortunately she passed away [there]. This was very distressing to the staff as they felt it would have been more dignified for the client to be in familiar surrounding.“

Own Comment -Comment by others -

Result „After discussing with the homes manager about the staff being upset, it was decided that staff who were most affected get together and discuss thoughts and feelings.“


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Impact of Collaborative Reflection AppsEffects of Talk Reflection on communication / reflection (Case 2)

Awareness for reflection“Since we are using the app, we are talking more to younger colleagues”

Improving attribution“It helped to talk about these situations in more detail instead of only saying ‘it was difficult‘”

Adoption and value added“It would be good if we had 10 minutes per day to use it. If you don’t have something to write down, you don’t have to”


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Impact of using the App


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Impact of the app and other factors


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The Evaluations of the Talk Reflection AppUsage Data

Activity ▪Most activity for documentation (and commenting in case 3)▪(Too) Little usage of commenting, hardly any for results documentation, but reflection and results in f2f communication▪All documents shared

Actions / Stats Case 1* Case 2 Case 3

Days of data capturing 12 33 49

Users 5 5 (6) 6 (7)

Documented conversations 7* 18 21

Comments (own / others) 9 (4/5) 14 (10/4) 45(32/13)

Documented reflection results 3 3 3


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The Evaluations of the Talk Reflection AppUsage Data

Slow Adoption: Influence factors▪Integration into work (“I asked them to use it in their breaks”)▪Communication of value added (“You do not go to the app to make a comment, but when you have something to document”)▪Lacking guidance (“I sometimes did not know what to comment”)

Actions / Stats Case 1* Case 2 Case 3

Days of data capturing 12 33 49

Users 5 5 (6) 6 (7)

Documented conversations 7* 18 21

Comments (own / others) 9 (4/5) 14 (10/4) 45(32/13)

Documented reflection results 3 3 3


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The Evaluations of the Talk Reflection App

▪ Inequality of usage: Top 3 users account for 2/3 (and more) of app usage:

Action Case 2 All (n=5) Top 3 Case2 Case 3 All (n=6) Top 3 Case3x

Log In 62 46 146 99

View Document 99 86 141 99

Create Document 18 13 21 17

Add Comment (Own / shared content) 14(10/4*) 9(8/1) 45(32/13) 35(24/11)

A matter of scale?


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Action U1 U2 U3 U4 U5 U6 anon total

Log in 17 21 8 5 16 32 2 101

View Document 21 33 12 14 20 45 1 146

Add Comment (shared / own content) 7(5/2) 5(5/0) 12(12/0) 3(1/2) 3(0/3) 13(7/6) 2(2/0) 45(32/13)

Create Document 2 1 1 4 7 6 0 21

▪ Commenter▪ Roles: Superior, Helper▪ “I made comments where I thought I could help colleagues”▪ Inequality in usage: Top 3 users account for 2/3 (and more) of app usage

▪ Documenter▪ Off-Loading, part of work ▪ “I documented when I thought this was relevant for colleagues”

User Preferences in the Talk Reflection


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Fostering tool usageBalancing between Social and Technical Reflection Support

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Escalating Prompts for Collaborative ReflectionCSCL at Work: Flexible guidance by prompts

▪ Notify users to motivate tool usage (“Can you think of a recent conversation?”)

▪ Make users aware of collaboration features: Motivate comments (“Have you been in a similar situation?”)

▪ Prompt regularly: Leave traces from f2f situations (“Did you come up with an idea for change?”)


Collaborative Reflection: Socio-Technical Design


reflection community

Scale: Community Support

Thanks for your attention. Questions?